Gender is something most people take for granted. Is it a girl or boy? Pink or blue, dolls or trucks, hopscotch or baseball?

In this binary world of ours, few things are more fundamental than gender identity in how we define each other and ourselves, how we understand our creation and how we become socialized beings.

The San Francisco Board of Supervisors last Monday stepped out of that black-and-white world for a moment to consider proposed legislation to pay for equal access to health care for transgender workers in city government. A vote on the measure was delayed last week, but it is expected to win approval by the full board tomorrow. No other government employer in the United States grants such benefits.

Until now, employees of the City and County of San Francisco have not had access to health care benefits related to their status as transgender individuals. Our Health Service System Board had not evaluated or negotiated insurance coverage for them.

In March, after completion of actuarial studies and consideration of the costs involved, the health board voted to include a significant though limited benefit for our transgender employees.

It was part of an expanded package of health coverage for all city workers. The proposed transgender benefits include psychotherapy, hormone therapy and "gender reassignment" surgery capped at $50,000 per employee.

Other components of the overall package expected to be approved by the supervisors on Monday include coverages for infertility, erectile dysfunction, hearing aids, elimination of a $50 annual pharmacy deductible and 100 percent coverage for immunizations.

Here's some background.

People whom we now call transgender have been part of human culture throughout history. For thousands of years before European colonization, so- called "Two-Spirit" people known as the Berdache were revered as religious leaders by many Native American tribes. Surgically altered eunuchs played vital roles in the ancient empires of Asia and the Near East.

In the early 1950s Dr. Harry Benjamin defined the medically diagnosed syndrome known as "gender identity disorder."

Those people with this condition experience a strong and continuing cross- gender identification and a need to live and be accepted as a member of the opposite sex. The currently accepted and effective model of treatment utilizes counseling, hormone therapy and sometimes surgery.

As a vocal advocate for transgender health benefits, I am often asked the same few questions.

The first is, "Will nose jobs be covered next?"

The answer, of course, is no. The health board has specifically excluded any elective therapies involving personal appearance. Electrolysis, facial reconstruction and breast augmentation, for example, are not included in the coverage.

Keep in mind that until now, a non-transgender employee with need of a mastectomy, hysterectomy, heart, kidney or liver treatment would be covered, while a transgender employee could be denied. City employees have psychological counseling costs covered, but not if they mention "transgender" to the therapist.

This legislation is not about providing cosmetic surgery to a small group of employees but making sure that transgender workers get the same rights as their colleagues.

The second frequent question: "Is this just for gay men?"

Gender identity and sexual orientation are very different subjects. City- employed men or women -- whether heterosexual, homosexual or bisexual -- would qualify for any of these benefits with the proper medical diagnosis.

The third question: "Is the cost worth the benefit for as few as 14 transgender employees?"

This strikes at the core of why this is a matter of basic human rights.

In recent years, San Francisco has led the charge for equal benefits for equal work. Since the passage of our Equal Benefits Ordinance in 1997, thousands of multinational corporations as well as small neighborhood businesses have come to learn that inequity in employee benefits is a thing of the past.

But we have accomplished much more than that. The intimate relationships of lesbians and gay men are now respected in a way unimaginable a decade ago.

Today, out of fear and misunderstanding, transgender citizens are often despised and disrespected. Let's proclaim their dignity. Let's honor their human right to participate fully as citizens of this great City of St. Francis.

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